| NPI | 1649506502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID pt-2924) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 36141) |
| Enumeration Date | 2009-10-28 |
| Last Update Date | 2011-09-13 |